Understanding Manual Therapy: A Scientific Guide to Fascia
Introduction
Recent scientific evidence has transformed our understanding of how manual therapy achieves its effects. While practitioners once believed they were directly manipulating fascia, research now shows that the beneficial effects of manual therapy occur primarily through neurological mechanisms. This guide presents key evidence supporting this understanding, arranged from most accessible to most technical.
For General Readers
"Does Fascia Matter?" (Ingraham, 2019).
https://www.painscience.com/articles/does-fascia-matter.php
This comprehensive article examines common claims about fascial manipulation and explains why many traditional beliefs about "releasing" fascia are biomechanically impossible. It provides an excellent foundation for understanding why we need to rethink how manual therapy works.
"Neurophysiological Effects of Manual Therapy" (Bialosky et al., 2018).
https://www.bodyinmind.org/neurophysiological-effects-manual-therapy/
This accessible article explains how touch influences our nervous system, demonstrating why gentle pressure can be as effective as forceful manipulation. It helps both practitioners and patients understand the actual mechanisms behind successful treatment.
Scientific Evidence - Core Papers
"Three-dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy" (Chaudhry et al., 2008).
https://www.ncbi.nlm.nih.gov/pubmed/18723456
This foundational paper uses mathematical modeling to demonstrate that the forces required to mechanically deform fascia far exceed what human hands can generate. The researchers calculated that it would take hundreds of pounds of force to create even small changes in fascial tissue - far beyond what's possible in manual therapy.
"A Fundamental Critique of the Fascial Distortion Model" (Lehmann et al., 2017).
https://www.sciencedirect.com/science/article/pii/S1360859217302097
This paper systematically examines and challenges common claims about fascial manipulation, providing a thorough scientific analysis of why direct mechanical changes to fascia during treatment are unlikely.
"Fascial plasticity – a new neurobiological explanation: Part 1" (Schleip, 2003) Journal of Bodywork and Movement Therapies, 7(1), 11-19
https://www.sciencedirect.com/science/article/abs/pii/S1360859202000679
This groundbreaking paper systematically examines the traditional mechanical model of fascial manipulation and demonstrates why it cannot work as previously believed. Using a combination of histological evidence and biomechanical principles, Schleip shows that fascia's inherent properties make it resistant to the kind of mechanical deformation many practitioners believe they are creating. The paper is particularly valuable because it bridges the gap between clinical experience and scientific understanding, helping explain why some long-held beliefs about fascial manipulation need to be reconsidered.
Advanced Research on Biomechanical Properties
"In Vivo Measurement of Human Lumbar Spine Creep" (McGill & Brown, 2021).
https://pubmed.ncbi.nlm.nih.gov/21419014
This research examines the actual forces required to create tissue deformation, providing concrete evidence that manual pressure cannot achieve the force levels necessary for structural change.
"Stiffness and Frictional Resistance of a Simulated Lumbar Facet Joint" (Ianuzzi et al., 1998).
https://www.sciencedirect.com/science/article/abs/pii/S0021929098001651
While focusing on joint surfaces, this paper provides crucial data about tissue mechanical properties that help explain why manual manipulation cannot directly alter fascial structures.
"Mechanical properties of human fasciae in manual therapy" (Chaudhry et al., 2007) Journal of Bodywork and Movement Therapies, 11(3), 268-277.
https://www.sciencedirect.com/science/article/abs/pii/S1360859206001082
This research paper provides precise mathematical evidence about fascial properties, using engineering principles to calculate the forces required for mechanical deformation. The findings are striking: creating even minimal strain in various types of fascia would require forces far beyond human capability. For example, the researchers demonstrated that creating a 1% strain in plantar fascia would require over 800 pounds of force, and even more pliable fascial tissues would need forces exceeding what human hands can generate. This paper is crucial because it provides concrete mathematical proof that traditional explanations of manual therapy's effects through direct mechanical change cannot be accurate.
Understanding the Real Mechanisms
"Effects of Manual Therapy on Pain and Mobility Are Not Mechanically Mediated" (Bialosky et al., 2019).
https://academic.oup.com/ptj/article/99/1/765/5107880
This paper explains the actual mechanisms behind manual therapy's effectiveness, showing how neurological responses, rather than mechanical tissue changes, create positive outcomes.
Chapter from "The Brain's Way of Healing" (Doidge, 2015).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890161/
This piece ties everything together by explaining how touch influences the nervous system to create positive changes without requiring mechanical tissue manipulation.
"Fascial plasticity – a new neurobiological explanation: Part 2" (Schleip, 2003) Journal of Bodywork and Movement Therapies, 7(2), 104-116.
https://www.sciencedirect.com/science/article/abs/pii/S1360859202000768
Having established in Part 1 why mechanical explanations are insufficient, this second paper presents a revolutionary new model based on neurobiological responses. Schleip details how fascia is densely innervated with mechanoreceptors and free nerve endings, making it an important sensory organ. The paper explains how manual contact triggers responses in the autonomic nervous system, leading to changes in local tissue tone and fluid dynamics through nervous system regulation rather than direct mechanical force. This understanding helps explain why gentle touch can be as effective as forceful manipulation - the key lies in communication with the nervous system rather than mechanical force. The paper provides specific examples of these mechanisms and their clinical implications, making it essential reading for understanding how manual therapy actually achieves its effects.
Key Takeaways
1. The forces required to mechanically change fascia exceed what human hands can generate.
2. Manual therapy's benefits come primarily through neurological mechanisms.
3. Understanding these mechanisms can lead to more effective treatment approaches.
4. Gentle touch can be as effective as forceful manipulation because the benefits occur through nervous system responses rather than mechanical tissue change.
Author
Dr. Mark Olson holds an M.A. in Education and a Ph.D. in Neuroscience from the University of Illinois, specializing in Cognitive and Behavioral Neuropsychology and Neuroanatomy. His research focused on memory, attention, eye movements, and aesthetic preferences. Dr. Olson is also a NARM® practitioner, aquatic therapist, and published author on chronic pain and trauma-informed care. He offers a variety of courses at Dr-Olson.com that provide neuroscientific insights into the human experience and relational skill training for professionals and curious laypersons.